SJRCC Dual Enrollment Registration/Approval Form



342900-20383500SJR State Dual Enrollment/Collegiate High School/Early AdmissionsRegistration/Approval?Form*This form must be completed each term/semesterCLASS LOCATION:SJR State site High School site_______ Year-Term _________ HIGH SCHOOL GRAD YEAR _________ NEW STUDENT RETURNING STUDENT ____________NAME:DATE OF BIRTH: ?/ ? / LastFirstMiddle ADDRESS:Mailing AddressCity State?Zip Code EMAIL: _________________________________________________ SJR STATE X NUMBER (REQUIRED): X00 __________________PHONE NUMBER: SCHOOL: I understand that I must have an unweighted 3.0 G.P.A. to participate in the Dual Enrollment Program.? In addition, I understand that should I make below a "C" (including a W grade for withdrawing) in any dual enrollment course, I will be permanently dropped from the program.STUDENT SIGNATURE: DATE: In accordance with Florida law, the Dual Enrollment Program at SJR State is a program of acceleration whereby a high school student earns COLLEGE CREDIT applicable towards an Associates Degree or college credit certificate WHILE AT THE SAME TIME EARNING required high school credit for a high school diploma.? Any public school student so enrolled is exempt from the payment of registration, matriculation, lab fees, and instructional materials. _______________________________________________________________________________________________________________Students must have an overall 3.0 unweighted?G.P.A. to participate in the Dual Enrollment Program.?? Subject area G.P.A.’s will not be considered.? Students must provide recent (within 2 year) results of American College Test (ACT), the Scholastic Aptitude Test (SAT), Florida College Entry Level Placement Test (CPT), or the Postsecondary Education Readiness Test (PERT).? OFFICIAL TEST SCORES MUST BE ON FILE TO ENROLL IN COLLEGE CREDIT DUAL ENROLLMENT COURSES.? Students planning to enroll in English or Math courses must attain a qualifying score.? Overall Unweighted GPA: Counselor’s Initials: This student is approved to take the following course(s) for Dual Enrollment and to satisfy the required high school credit.? (Please list course title by name as it appears in the College Catalog.)? CRN/SectionNumberCreditHoursD.E.CodeCourse Prefix &NumberSJR State Course TitleTimesMTWRFTotal HoursI hereby certify that this student has demonstrated the maturity, motivation, dependability and academic ability to perform satisfactorily at the College Level.X X Signature of High School CounselorDateSignature of Principal or Official DelegateDateRevised 10/19 ................
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